Encounter
Overview
A patient encounter is further characterized by the setting in which it takes place. An Encounter encompasses the lifecycle from pre-admission, the actual encounter (for ambulatory encounters), and admission, stay and discharge (for inpatient encounters). During the encounter the patient may move from practitioner to practitioner and location to location.
This profile is used to define the content that will be returned by the API Server in response to requests to access Encounter resources. All elements described in the Definition and Detailed Definitions below are supported, which means that the API Server is capable of supplying these fields from the product database when they have been populated via the product or its APIs.
This resource is referenced by: Condition, DiagnosticReport, DocumentReference, Immunization, MedicationRequest, Observation, Procedure.
List of profiles we support:
Definition
The official URL for this profile is:
https://fhir.athena.io/StructureDefinition/ah-encounter
The base definition for this profile is:
Name | Flags | Card. | Type | Description & Constraints![]() | ||||
---|---|---|---|---|---|---|---|---|
![]() ![]() | 0..* | Encounter | An interaction during which services are provided to the patient | |||||
![]() ![]() ![]() | Σ | 0..1 | string | Logical id of this artifact | ||||
![]() ![]() ![]() | Σ | 0..1 | Meta | Metadata about the resource | ||||
![]() ![]() ![]() | ?!Σ | 0..1 | uri | A set of rules under which this content was created | ||||
![]() ![]() ![]() | 0..1 | code | Language of the resource content Binding: CommonLanguages (preferred): A human language.
| |||||
![]() ![]() ![]() | 0..1 | Narrative | Text summary of the resource, for human interpretation | |||||
![]() ![]() ![]() | 0..* | Resource | Contained, inline Resources | |||||
![]() ![]() ![]() | 1..* | Extension | Extension Slice: Unordered, Open by value:url | |||||
![]() ![]() ![]() | 0..1 | Reference(Organization) | athenahealth Chart Sharing Group URL: https://fhir.athena.io/StructureDefinition/ah-chart-sharing-group | |||||
![]() ![]() ![]() | 1..1 | Reference(Organization) | athenahealth Practice URL: https://fhir.athena.io/StructureDefinition/ah-practice | |||||
![]() ![]() ![]() | ?! | 0..* | Extension | Extensions that cannot be ignored | ||||
![]() ![]() ![]() | Σ | 0..* | Identifier | Identifier(s) by which this encounter is known | ||||
![]() ![]() ![]() | ?!Σ | 1..1 | code | planned | arrived | triaged | in-progress | onleave | finished | cancelled + Binding: EncounterStatus (required): Current state of the encounter. | ||||
![]() ![]() ![]() | Σ | 1..1 | Coding | Classification of patient encounter Binding: ActEncounterCode (extensible): Classification of the encounter. | ||||
![]() ![]() ![]() | Σ | 0..* | CodeableConcept | Specific type of encounter Binding: EncounterType (example): The type of encounter. | ||||
![]() ![]() ![]() | Σ | 0..1 | Reference(Patient) | The patient present at the encounter | ||||
![]() ![]() ![]() | Σ | 0..* | BackboneElement | List of participants involved in the encounter | ||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | Σ | 0..* | CodeableConcept | Role of participant in encounter Binding: ParticipantType (extensible): Role of participant in encounter. | ||||
![]() ![]() ![]() ![]() | 0..1 | Period | Period of time during the encounter that the participant participated | |||||
![]() ![]() ![]() ![]() | Σ | 0..1 | Reference(Practitioner) | Persons involved in the encounter other than the patient | ||||
![]() ![]() ![]() | 0..1 | Period | The start and end time of the encounter | |||||
![]() ![]() ![]() | Σ | 0..* | CodeableConcept | Coded reason the encounter takes place Binding: EncounterReasonCodes (preferred): Reason why the encounter takes place. | ||||
![]() ![]() ![]() | 0..1 | BackboneElement | Details about the admission to a healthcare service | |||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | 0..1 | CodeableConcept | Category or kind of location after discharge Binding: DischargeDisposition (example): Discharge Disposition. | |||||
![]() ![]() ![]() | 0..* | BackboneElement | List of locations where the patient has been | |||||
![]() ![]() ![]() ![]() | 0..1 | string | Unique id for inter-element referencing | |||||
![]() ![]() ![]() ![]() | 0..* | Extension | Additional content defined by implementations | |||||
![]() ![]() ![]() ![]() | ?!Σ | 0..* | Extension | Extensions that cannot be ignored even if unrecognized | ||||
![]() ![]() ![]() ![]() | 1..1 | Reference(Location) | Location the encounter takes place | |||||
![]() |
Detailed Definitions
Encounter
An interaction between a patient and healthcare provider(s) for the purpose of providing healthcare service(s) or assessing the health status of a patient.
Cardinality | 0..* |
Type | Root |
Encounter.id
The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes.
Cardinality | 0..1 |
Type | string |
Comments | The only time that a resource does not have an id is when it is being submitted to the server using a create operation. |
Encounter.meta
The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
Cardinality | 0..1 |
Type | Meta |
Encounter.implicitRules
A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc.
Cardinality | 0..1 |
Type | uri |
Comments | Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc. |
Encounter.language
The base language in which the resource is written.
Cardinality | 0..1 |
Type | code Binding: CommonLanguages (preferred) |
Comments | Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute). |
Encounter.text
A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
Cardinality | 0..1 |
Type | Narrative |
Comments | Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later. |
Encounter.contained
These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope.
Cardinality | 0..* |
Type | Resource |
Comments | This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels. |
Encounter.extension:ahChartSharingGroup
An Extension used to reference a specific athenahealth chart sharing group Organization.
Cardinality | 0..1 |
Type | Extension(AthenaChartSharingGroup) |
Encounter.extension:ahPractice
An Extension used to reference a specific athenahealth practice Organization.
Cardinality | 1..1 |
Type | Extension(AthenaPractice) |
Encounter.modifierExtension
May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality | 0..* |
Type | Extension |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Requirements | Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Encounter.identifier
Identifier(s) by which this encounter is known.
Cardinality | 0..* |
Type | Identifier |
Encounter.status
planned | arrived | triaged | in-progress | onleave | finished | cancelled +.
Cardinality | 1..1 |
Type | code Binding: EncounterStatus (required) |
Comments | Note that internal business rules will determine the appropriate transitions that may occur between statuses (and also classes). |
Encounter.class
Concepts representing classification of patient encounter such as ambulatory (outpatient), inpatient, emergency, home health or others due to local variations.
Cardinality | 1..1 |
Type | Coding Binding: v3.ActEncounterCode (extensible) |
Encounter.type
Specific type of encounter (e.g. e-mail consultation, surgical day-care, skilled nursing, rehabilitation).
Cardinality | 0..* |
Type | CodeableConcept Binding: EncounterType (example) |
Comments | Since there are many ways to further classify encounters, this element is 0..*. |
Encounter.subject
The patient present at the encounter
Cardinality | 0..1 |
Type | Reference(Patient) |
Comments | While the encounter is always about the patient, the patient might not actually be known in all contexts of use, and there may be a group of patients that could be anonymous (such as in a group therapy for Alcoholics Anonymous - where the recording of the encounter could be used for billing on the number of people/staff and not important to the context of the specific patients) or alternately in veterinary care a herd of sheep receiving treatment (where the animals are not individually tracked). |
Encounter.participant
The list of people responsible for providing the service.
Cardinality | 0..* |
Type | BackboneElement |
Encounter.participant.id
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality | 0..1 |
Type | string |
Encounter.participant.extension
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality | 0..* |
Type | Extension |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Encounter.participant.modifierExtension
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality | 0..* |
Type | Extension |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Requirements | Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Encounter.participant.type
Role of participant in encounter.
Cardinality | 0..* |
Type | CodeableConcept Binding: ParticipantType (extensible) |
Comments | The participant type indicates how an individual participates in an encounter. It includes non-practitioner participants, and for practitioners this is to describe the action type in the context of this encounter (e.g. Admitting Dr, Attending Dr, Translator, Consulting Dr). This is different to the practitioner roles which are functional roles, derived from terms of employment, education, licensing, etc. |
Encounter.participant.period
The period of time that the specified participant participated in the encounter. These can overlap or be sub-sets of the overall encounter's period.
Cardinality | 0..1 |
Type | Period |
Encounter.participant.individual
Persons involved in the encounter other than the patient.
Cardinality | 0..1 |
Type | Reference(Practitioner) |
Encounter.period
The start and end time of the encounter.
Cardinality | 0..1 |
Type | Period |
Comments | If not (yet) known, the end of the Period may be omitted. |
Encounter.reasonCode
Reason the encounter takes place, expressed as a code. For admissions, this can be used for a coded admission diagnosis.
Cardinality | 0..* |
Type | CodeableConcept Binding: EncounterReasonCodes (preferred) |
Comments | For systems that need to know which was the primary diagnosis, these will be marked with the standard extension primaryDiagnosis (which is a sequence value rather than a flag, 1 = primary diagnosis). |
Encounter.hospitalization
Details about the admission to a healthcare service.
Cardinality | 0..1 |
Type | BackboneElement |
Comments | An Encounter may cover more than just the inpatient stay. Contexts such as outpatients, community clinics, and aged care facilities are also included. The duration recorded in the period of this encounter covers the entire scope of this hospitalization record. |
Encounter.hospitalization.id
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality | 0..1 |
Type | string |
Encounter.hospitalization.extension
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality | 0..* |
Type | Extension |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Encounter.hospitalization.modifierExtension
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality | 0..* |
Type | Extension |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Requirements | Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Encounter.hospitalization.dischargeDisposition
Category or kind of location after discharge.
Cardinality | 0..1 |
Type | CodeableConcept Binding: DischargeDisposition (example) |
Encounter.location
List of locations where the patient has been during this encounter.
Cardinality | 0..* |
Type | BackboneElement |
Comments | Virtual encounters can be recorded in the Encounter by specifying a location reference to a location of type "kind" such as "client's home" and an encounter.class = "virtual". |
Encounter.location.id
Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
Cardinality | 0..1 |
Type | string |
Encounter.location.extension
May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension.
Cardinality | 0..* |
Type | Extension |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Encounter.location.modifierExtension
May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself).
Cardinality | 0..* |
Type | Extension |
Comments | There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone. |
Requirements | Modifier extensions allow for extensions that *cannot* be safely ignored to be clearly distinguished from the vast majority of extensions which can be safely ignored. This promotes interoperability by eliminating the need for implementers to prohibit the presence of extensions. For further information, see the definition of modifier extensions. |
Interactions
READ
Read interactions are executed as specified in the HL7 FHIR RESTful API read specification. To read Encounter resources, an application will perform an HTTP GET specifying the logical ID of the Encounter being retrieved.
The [patient|user|system]/Encounter.read authorization scope is required.
Parameters
❙ required
❙ conditional required
Name | Type | Description |
logicalId | string | (REQUIRED) The logical ID of the resource (alias: Resource.id). It is specified in the URL path and not as a query parameter. |
Response Codes
Response code | Description |
200 OK | The requested Encounter resource was found and is contained within the body of the HTTP response. |
400 Bad Request | The server could not understand the request due to invalid syntax. The body of the HTTP response will contain an OperationOutcome resource that indicates the invalid request could not be processed. |
404 Not Found | The requested resource does not exist. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found. |
410 Gone | The requested resource has been permanently deleted from server with no forwarding address. The body of the HTTP response will contain an OperationOutcome resource that indicates the resource could not be found. |
500 Internal Server Error | The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error. |
5xx Server Error | The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error. |
GET SEARCH
Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for Encounter resources using the HTTP GET method, an application will perform the HTTP GET specifying the query parameters associated with the Encounter in the URL.
The [patient|user|system]/Encounter.read authorization scope is required.
The following additional authorization scopes might be required depending on _include
and/or _revinclude
search parameters used:
- [patient|user|system]/Organization.read
- [patient|user|system]/Patient.read
- [patient|user|system]/Provenance.read
Parameters
Encounter search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:- patient
- _id
❙ required
❙ conditional required
Name | Type | Description |
ah-practice | reference | Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]') |
_id | token | (CONDITIONAL REQUIRED) Encounter.id resource reference to FHIR Encounter resource |
patient | reference | (CONDITIONAL REQUIRED) Encounter.patient resource reference to FHIR Patient resource |
date | date | Encounter.period resource reference to FHIR Period resource |
_count | number | The number of Encounter resources to return per page for paged search results. |
cursor | token | Search by cursor token for first resource to return in a paged search result |
ah-chart-sharing-group | reference | Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension |
_include | string | Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
|
_revinclude | string | Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
|
Response Codes
Response code | Description |
200 OK | The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search. |
403 Forbidden | The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters. |
500 Internal Server Error | The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error. |
5xx Server Error | The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error. |
POST SEARCH
Search interactions are executed as specified in the HL7 FHIR RESTful API search specification. To search for Encounter resources using the HTTP POST method, an application will perform the HTTP POST specifying the query parameters associated with the Encounter in the request body.
The [patient|user|system]/Encounter.read authorization scope is required.
The following additional authorization scopes might be required depending on _include
and/or _revinclude
search parameters used:
- [patient|user|system]/Organization.read
- [patient|user|system]/Patient.read
- [patient|user|system]/Provenance.read
Request Header
Content-Type: application/x-www-form-urlencoded
Request Body
param1=value1¶m2=value2...
Parameters
Encounter search requests conditionally require one of the following search parameters or search parameter combinations in order to match and return a result set:- patient
- _id
❙ required
❙ conditional required
Name | Type | Description |
ah-practice | reference | Identify the athenahealth Practice Organization (e.g., 'ah-practice=Organization/a-1.Practice-[practiceId]') |
_id | token | (CONDITIONAL REQUIRED) Encounter.id resource reference to FHIR Encounter resource |
patient | reference | (CONDITIONAL REQUIRED) Encounter.patient resource reference to FHIR Patient resource |
date | date | Encounter.period resource reference to FHIR Period resource |
_count | number | The number of Encounter resources to return per page for paged search results. |
cursor | token | Search by cursor token for first resource to return in a paged search result |
ah-chart-sharing-group | reference | Search by athenahealth Chart Sharing Group (e.g., 'ah-chart-sharing-group=Organization/a-[practiceId].CSG-[csgId]') for resources containing the 'Athena Chart Sharing Group' Extension |
_include | string | Requests the server to include the referenced resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _include parameter values are:
|
_revinclude | string | Requests the server to include the associated resource(s) in the search results according to the specified search parameter. Additional authorization scope(s) will be required. The supported _revinclude parameter values are:
|
Response Codes
Response code | Description |
200 OK | The search request succeeded. The body of the HTTP response will contain a Bundle resource containing the results of the search. |
403 Forbidden | The server refused to perform the search due to a missing required search parameter. The body of the HTTP response will contain an OperationOutcome resource that includes the required search parameters. |
500 Internal Server Error | The server has encountered a situation it doesn't know how to handle. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error. |
5xx Server Error | The server may return other error codes to indicate other error conditions. The body of the HTTP response will contain an OperationOutcome resource that indicates the nature of the error. |